2013-11-14T15:19:39-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-01-01 800276405 ASSUMPTION COMMUNITY SERVICES INC ASSU 3206853693 715 1ST ST N COLD SPRING MN 56320 JAN LUTHENS 3206853693 2013-11-13 1 GORDON J VETSCH P00047306 6123764500 2012 2016-02-24 21:20:13Z JAN LUTHENS 715 1ST ST N COLD SPRING MN 56320 485776 0 X WWW.ASSUMPTIONHOME.COM X 2008 MN PROVIDE A CONTINUUM OF HEALTH AND RESIDENTIAL SERVICES IN A CHRISTIAN ENVIRONMENT. 15 15 0 183 0 0 55737 63345 140639 180915 145 -66924 960 -1368 197481 175968 0 4083 0 0 0 171567 0 0 0 0 95209 0 270859 197481 -94891 390368 104765 616546 425834 -226178 -321069 X TO PURSUE EXCELLENCE IN PROVIDING A CONTINUUM OF HEALTH AND RESIDENTIAL SERVICES IN A CHRISTIAN ENVIRONMENT 1 0 204116 4083 180915 COMMUNITY HEALTH SERVICES PROVIDES CLASS A HOME CARE, TRANSPORTATION, HOMEMAKING CHORE SERVICE, HOME MODIFICATIONS, AND OTHER HEALTH RELATED PROGRAMS. 204116 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X JAN LUTHENS 3206853693 715 1ST ST N COLD SPRING MN 56320 MARY WENNER 1.00 2.00 X 0 0 0 REVEREND CLETUS CONNERS 1.00 2.00 X 0 0 0 DOROTHY PFLIPSEN 1.00 2.00 X 0 0 0 ROD PAUSER 1.00 2.00 X 0 0 0 ADAH EBELING 1.00 2.00 X 0 0 0 JUDY KEARIN 1.00 2.00 X X 0 0 0 DALE JOB 1.00 2.00 X X 0 0 0 DON EIKMEIER 1.00 2.00 X 0 0 0 RICHARD KRUEGER 1.00 2.00 X 0 0 0 ROXANNE DORWEILER 1.00 2.00 X X 0 0 0 SISTER JUDY SCHAFFER 1.00 2.00 X 0 0 0 SISTER MIRIAM ARDOLF 1.00 2.00 X 0 0 0 BEVERLY LAHR 1.00 2.00 X 0 0 0 JACK BELL 1.00 2.00 X 0 0 0 CLARENCE DINGMANN 1.00 2.00 X 0 0 0 JAN LUTHENS 5.00 35.00 X 0 87242 10144 0 87242 10144 0 0 0 0 0 63345 63345 SKILLED NURSING REVENU 623000 166484 166484 MEALS ON WHEELS 624210 14431 14431 180915 105 105 240000 307029 -67029 -67029 -67029 1411 2779 -1368 -1368 175968 180915 0 -68292 4083 4083 153844 120346 33498 6085 4760 1325 11638 9104 2534 4170 4170 14311 14311 12836 12836 7463 4331 3132 15594 15594 868 868 9556 9556 3331 3331 7316 1001 6315 FOOD COSTS 17129 17129 LICENSE, PERMITS & FEES 863 688 175 MEMBERSHIP/ASSOCIATION 645 645 TRAINING 631 631 496 496 270859 204116 66743 0 88915 64821 7523 24419 529 352 0 0 293401 0 0 15173 390368 104765 5374 27401 611172 398433 616546 425834 X -226178 -321069 -226178 -321069 390368 104765 -94891 0 X 0 0 0 X 54908 57098 49768 63345 225119 23302 48384 140639 180915 393240 78210 105482 190407 244260 618359 0 0 0 618359 85 59 145 105 394 85 59 145 105 394 1411 1411 78295 105541 190552 245776 620164 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: GAMBLING INCOME - 2012 AMOUNT: $ 1,411. 0 DUE TO AFFILIATE 15173 15173 DUE FROM AFFILIATE 398433 398433 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 CHARITABLE GAMBLING FORM 990, PART VI, SECTION A, LINE 1 DIFFERENCES IN VOTING RIGHTS: THREE DIRECTORS - THE PASTOR AND TWO TRUSTEES OF ST. BONIFACE CATHOLIC CHURCH, COLD SPRING, MN - ALSO SERVE AS MEMBERS OF THE ORGANIZATION. AS MEMBERS, THESE THREE INDIVIDUALS HAVE THE POWER TO PROPOSE AND VOTE ON THE APPOINTMENT OF THE OTHER EIGHT DIRECTORS. ADDITIONALLY, THESE SAME THREE DIRECTORS/MEMBERS HAVE THE POWER TO DISCHARGE ANY DIRECTOR THROUGH A MAJORITY VOTE OF THE FIVE MEMBERS. EXECUTIVE COMMITTEE: THE BOARD OF DIRECTORS DESIGNATED THREE OF ITS MEMBERS TO CONSTITUTE AN EXECUTIVE COMMITTEE. TO THE EXTENT DETERMINED BY THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS AND THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL ACT ONLY IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS AND SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION ARE AS FOLLOWS: 1. THE BISHOP OF THE DIOCESE OF ST. CLOUD, OR THE PERSON WHO, IN HIS STEAD, EXERCISES ORDINARY JURISDICTION OVER THE SPIRITUAL AND TEMPORAL AFFAIRS OF THE DIOCESE OF ST. CLOUD, IN ACCORDANCE WITH THE LEGISLATION OF THE ROMAN CATHOLIC CHURCH; 2. THE VICAR GENERAL OF THE DIOCESE OF ST. CLOUD, WHO HAS BEEN APPOINTED TO BE A MEMBER EX-OFFICIO OF THE CORPORATION OF THE DIOCESE OF ST. CLOUD. IN THE EVENT OF A VACANCY IN THE OFFICE OF THE BISHOP, OR IN THOSE CASES IN WHICH THE VICAR GENERAL'S OFFICE CEASES, THEN AND IN SUCH EVENT THE PERSON WHO WAS THE VICAR GENERAL SHALL CONTINUE TO BE A MEMBER EX-OFFICIO OF THIS CORPORATION WITH ALL THE RIGHTS AND POWERS INCIDENT THERETO, BUT HIS MEMBERSHIP SHALL CEASE AT ONCE WHEN THE OFFICE OF VICAR GENERAL HAS BEEN FILLED; 3. THE PASTOR OF ST. BONIFACE CATHOLIC CHURCH, COLD SPRING, MINNESOTA; 4. THE TWO TRUSTEES OF ST. BONIFACE CATHOLIC CHURCH, COLD SPRING, MINNESOTA, WHICH HAVE BEEN DESIGNATED AS THE TRUSTEES OF SAID PARISH PURSUANT TO THE PROVISIONS OF SECTION 315.15 OF THE MINNESOTA STATUTES, AND THEIR SUCCESSORS. FORM 990, PART VI, SECTION A, LINE 7A THREE DIRECTORS - THE PASTOR AND TWO TRUSTEES OF ST. BONIFACE CATHOLIC CHURCH, COLD SPRING, MN - ALSO SERVE AS MEMBERS OF THE ORGANIZATION. AS MEMBERS, THESE THREE INDIVIDUALS HAVE THE POWER TO PROPOSE AND VOTE ON THE APPOINTMENT OF THE OTHER EIGHT DIRECTORS. ADDITIONALLY, THESE SAME THREE DIRECTORS/MEMBERS HAVE THE POWER TO DISCHARGE ANY DIRECTOR THROUGH A MAJORITY VOTE OF THE FIVE MEMBERS. IN ADDITION TO THE THREE BOARD MEMBERS INCLUDED ABOVE, THE OTHER EIGHT DIRECTORS ARE ELECTED BY THE MEMBERS OF THE CORPORATION AND SHALL SERVE IN THAT CAPACITY AT THE PLEASURE OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS MADE TO THE ARTICLES OF INCORPORATION AND BYLAWS MUST BE APPROVED BY A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM AND IS REVIEWED BY BOTH THE ADMINISTRATOR AND THE DIRECTOR OF FINANCE. AFTER THEIR REVIEW, THE 990 IS EMAILED TO THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS. THE ADMINISTRATOR ANNUALLY REVIEWS THE BOARD MEMBERS' ASSOCIATIONS FOR CONFLICTS OF INTEREST. THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE ADMINISTRATOR'S ASSOCIATIONS FOR CONFLICTS OF INTEREST. IF A CONFLICT ARISES, DEPENDING ON THE CIRCUMSTANCES, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING, STEPS DOWN FROM THE BOARD OR TERMINATES THEIR ASSOCIATION WITH THE OTHER PARTY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. ASSUMPTION HOME INC 715 N 1ST STREET COLD SPRING MN 56320 410873335 NURSING HOME MN 501(C)(3) 9 N/A 0 PIONEER HOUSING DEVELOPMENT 200 8TH AVENUE NORTH COLD SPRING MN 56320 411367392 HOUSING MN 501(C)(3) 9 N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0